Cincinnati Children's Hospital Medical Center (CCHMC) is one of the largest comprehensive pediatric medical centers in the United States and a recognized leader in clinical care, research, and training relative to the health and diseases of infants and children. CCHMC provides inpatient hospital care and outpatient subspecialty services for virtually all newborns, infants, and children residing in the greater Cincinnati region. In 2009, CCHMC announced the establishment of the CCHMC Perinatal Institute with the mission to improve the health of all newborn infants through innovation in science, clinical care, education, training and community outreach. The Perinatal Institute builds upon a 20-year evolution and integration of research and clinical programs within the Division of Neonatology and Pulmonary Biology. The Division of Neonatology has maintained membership in the Eunice Kennedy Schriver NICHD Neonatal Research Network (NRN) for 20 years. Over that time clinical investigators in the Division have established a record of clinical research productivity based on: 1) consistently high levels of enrollment; 2) consistently high levels of follow-up; and 3) a past record of thought leadership. CCHMC is also well positioned for future intellectual contribution to the NRN. CCHMC and University of Cincinnati (UC) have been granted a CTSA award which provides resources to enable community-wide and multicenter translational research at all levels. Incorporation of accurate phenotyping and specimen accrual into Network studies will facilitate translation of basic discoveries to human applications. Faculty and institutional strengths at CCHMC will add value to NRN studies by engagement of basic and translational science. Examples include: 1) Pulmonary Biology - discovery of genetic programs regulating lung development led by Dr. Jeff Whitsett; 2) Perinatal Biology - understanding the influence of fetal inflammation on pulmonary outcome led by Dr. Alan Jobe; and 3) Human Milk Sciences - investigating the importance of bioactive substance in milk led by Dr. Ardythe Morrow. This cutting-edge research will inform the use of genomics and other high throughput technologies to understand the molecular underpinning of neonatal diseases and identify targets for their prevention and treatment. PUBLIC HEALTH RELEVANCE (See instructions): The charge of the NICHD NRN is to conduct large clinical studies to evaluate and improve preventative, diagnostic and therapeutic strategies for the care of newborn infants. We propose to test the hypothesis that judicious early empirical antibiotic use among preterm infants will improve their survival without NEC. The concept incorporates mechanistic studies and quality improvement methods for study implementation.